Do we rely too heavily on technology for medical diagnosis?

This week in my bioelectricity class, we discussed electric fields that can be measured on the body (eg the brain, skin, eyes) and the ability to interpret signals for diagnosis, lie detection etc. Currently, there exists clinical decision support systems (CDSS), which are interactive computer software systems designed to aid doctors with medical decisions. Various test results and other data from the patient is inputted into a CDSS which then processes it and provides a list of possible diagnosis and options for treatment. The problem is, like all machines, they can often make crucial mistakes.

Dr. Lisa Sanders, a physician at Yale School of Medicine, and technical adviser for the popular TV show, House, wrote a book called “Every Patient Tells a Story” dealing with the uncertainty doctors face when analyzing a patient’s symptoms. Sanders says that misdiagnoses account for as much as 17% of medical errors. She discusses how despite the many technological advances made recently, sometimes these diagnostic tools are to blame. Relying too heavily on machines and lab results can result in symptoms being missed. Or on the other hand, sometimes exam results are normal; blood tests, electrocardiograms, CT scans, all may suggest a healthy body even when that is not the case. It can take a trained, experienced eye to notice small details in the patients’ behavior to unravel the mysteries of an unknown illness. Sanders states, “For all the data they collect, machines lack important components for diagnosis. They cannot hear a patient’s story, touch a patient’s skin, or look into a patient’s eyes.”

My question is, have we become too dependent on machines and technology to make medical decisions for us? Have doctors been lured into a false sense of security by allowing tools like CDSS to provide answers? How can the value of intuition which comes only from experience be balanced with technology without being lost? Can machines ever be a good enough substitute for doctors?

I understand the concern, and I think it is important to train doctors to realize that machine-produced data should not alone dictate their diagnosis. It requires an experienced eye to check the validity of machine-produce data, and vice versa. As long as doctors equally value their experience and machines and do not rely too heavily on either one, I think technology can only help us in medical diagnosis.

Humans make mistakes as well. In most cases, human error occurs much more frequently than machine error. Technology is quite useful when it comes to redundancy of outputs and consistency. However, the most fool-proof way would be to have a check system where the doctor and machine must be in accordance. The reliance on technology is useful as it save human time and allows for a higher level of productivity.

Apr 3 2013:
Jon has a great point. I think that Doctors and Computer technology must act together. Building on each's ideas and discoveries.

Doctors today gain SO MUCH information from the medical technology at their fingertips. In fact, when one hospital doesn't have the right test equipment, they'll send out a patient to get a certain test just because every bit of extra information can make a difference!

However, as Neema suggests, there is a case to say that perhaps too much weight is placed on the information of a computer. Computers have an incredible ability to synthesize information and compute probabilities, but they cannot think outside of the box (literally) when it comes to information that needs to be viewed in a more creative manner. This is why Dr. House gained so much popularity. He was a doctor who was able to come up with diagnoses based on facts that were often NOT based in medicine or tests. There is so many more factors than just test results that go into proper doctoring and ultimately that is why services such as webMD.com will never truly be able to replace good old fashioned medicine!

Thank you for posing this question, it is definitely a very important one to discuss. I do think that in a lot of cases we have become too dependent on technology, not just medically. If electricity would one day disappear, our society will not understand how to recreate and advance in many ways. This is a tremendous loss to the intellectual brain.

In the case of medical diagnosis, I think Dr. Lisa Sanders is right. Medical conditions are often dependent on personal details that machines fail to capture. Doctors need to understand the patient in order to be able to diagnose the condition properly.

Mar 31 2013:
The answer to this question is yes, as it is to any group becoming too reliant on technology. Like all things in life it is about balance. The best practitioners of any skill balance the old and the new, technology and intuition, patience and agression. Those that understand the balance are the ones that can turn a skill into an art.

For thoe who have decreed it is about generating revenue, you may be right in a few cases. In my experience though, it has been more about the fear of loosing money from having to pay out a settlement on a lawsuit, rather than generating the revenue of the test itself.

In listeneing to many medical practitioners at different levels I think the biggest and fastest growing shortcoming is the ability to listen. Society is moving away from direct perosn to person, face to face contact, and the ability to ask questions, listen for nuance andsubtelty in answers and then answer patient questions seems to me to be the bigger lost art that would negate much of the need for excess technology.

Out of no experience, only opinion, I also agree that we rely too heavily on technology for medical diagnoses. Apart from the misdiagnoses and lawsuits and money settlements, the loss of personal care and and custom patient diagnostics is getting lost in the wires of technology. Medicine is no longer about understanding the patient, the story and the symptoms, but about being able to control a machine and read what it pops out. This isn't to say that medicine has lost the need for skill and education, but I fear that push-a-button technology makes room for much error and turns medicine into more of a business than an honorable profession.

Apr 2 2013:
I have been a paramedic for over 20 years Swetha. I see this craving for technology from both sides of the equation. Not only do the practitioners want this high tech protection, but I think the patients do as well. I have seen and heard patients unhappy that providers are not more aggressive in providing the latest technology in testing, when old fashioned testing is proven to be just as efficient or older treatments just as effective. Newer is better, it is what has made Apple into the giant it is.

As for me, I say more technology. My position assumes most doctors are incompetent. There is a kind of blind arrogance that many have. They just make judgments after half reading chats and half listening. Some are fundamentally biased. Knowing this, I would strongly encourage not only more technology, but also data inputs on the patient side that describes symptoms. These inputs can be accomplished in a physician's office, and while the patient is waiting to be seen by his or her doctor. Once these things are inputted, certain triggering analyses may take place to help the physician make best judgment decisions.

I am actually developing a module that addresses this issue, If interested, feel free to contact me.

I think this concept of both practitioner and patient controlling inputs to produce a possible result is absolutely the right direction. I do see a problem, in that so much of our population is not comfortable with technology and I am not sure if they will provide that part of the inputs accurately. I think this has some fantastic aplications in distance treatment of patients or in using sealth care surrogates to expand our service networks and allow more in home attention and time with patients. It might not be M.D. with patient time, but surrogate with patient time that then translates to better information to MD and better use of MD time. Sounds optimal. I would love to see how you envision using this approach.

As to the arrogance or Messiah complex of many in the health care profession, it is a difficult line to walk. I want a surgeon with b**ls made of iron and as big as grapefruits who is unflustered by whatever he or she meets while I am on the table. But before that, I want a diagnostician who is communicative and questioning and willing to second guess herself. And afterwards, I want a practitioner who is warm and caring and knows how to work with all the devils within my psyche to get me on my feet and on the mend in the fastest possible time.

I think most persons, sans the very elderly, critically injured, or those with physical challenges can manipulate a simply designed medical UI. Just think of the millions of people around the world who input data into things like Facebook. They tend to get it right.

Mar 31 2013:
There's a precursor to this question that should consider the quality of a healthy experience. In the US we tend to rely on governance to dictate our expectations of health and in turn our perception of a reasonable diagnosis and outcome. All while using presumptions of freedom to promote and shape our efficacy. Considering the ridiculous things that the FDA, EPA, etc endorse subjecting our bodies to without hesitation, diagnostic conflict and divergence should be expected. Practicioners in every field at some point begin to feel as if their tasks are sisyphean, the burden of proper advocacy falls to them and their ability to positively challenge perception and effectiveness. Similarly confidence is a feature of every bartered trade and product, in medicine safety and security is a more pronounced component in healthcare as opposed to other industries. As such it's also a major point of leverage for bad decision making processes.

To answer your core question, practicing medicine is a technological process. Be it a stethoscope, or the ability for a patient to effectively communicate their symptoms, depth of knowledge and ability is an immutable constraint of quality. Experiences institutionalized within a defunct system will never be able to keep up with the dangers we introduce into ourselves and our environment. Be it technology co-opted to cause harm or resolve it, the nature of our ethos will always be pitted against the quality of our experience.

However students of health and medicine will likely continue to misplace their affinity for the field of study as well as their genuine interest in it. As they approach their education as standardized rigor, with less and less direct practicality, their lack of fear and accountability in the pursuit of being practicioners will likely degrade the actual benefit of their participation in the industry.

Mar 31 2013:
Interesting conversation!
Has anyone considered the value of testing in remote-access medicine? I'm thinking about experiments in the US with telemedicine communications between isolated practitioners in remote settings via internet access to experts in large medical centers with access to sophisticated testing facilities. Some test result analysis can be requested via long distance (blood work and the like, or analysis of X-Ray images). Expert physicians are called upon to consult in the analysis and interpretation of test results in the patients' home town with their primary healthcare provider. This offers the benefit of extra input for isolated practitioners and no need for patients to travel a great distance for (at least initial) medical evaluation.

I totally agree that remote-access medicine would benefit the outlook of medical care across the globe. This idea is among many that I think would augment the work of physicians both now and in the future through the use of technology. We could definitely use more of this, and other technology encouraging physicians to communicate and collaborate.

I just want to point out that like any good thing, too much of it could be harmful. I suppose the question at the heart of this conversation is as follows: how much medical technology is too much? Clearly, the question and the answer are both dynamic entities, which makes it rather difficult to nail down a quasi-definite solution...

Mar 31 2013:
I don't think machines can replace good doctors, whose diagnoses are made by coupling facts with experience. As far as I can tell, there are two broadly defined ways of thinking about making diagnoses:

1) One that emphasizes experience over fact. Ayurveda and other "eastern" ways might fall into this category because they draw on extremely long traditions of observation and experience. For example, like Jayprakash mentioned, an Ayurvedic doctor can take an almost insignificant fact (subtle variations within the pulse), and relate it to the centuries of experience that has gathered in the course of the Ayurvedic tradition.

2) One that emphasizes fact over experience. The western tradition falls into this category. Here, doctors gather masses of factual data, and look for trends. One's experience is limited to how often one has seen a trend, and since technology is capable of furnishing us with such copious factual information (upon which we base our experience), western medicine has become very technological.

Naturally, these gross simplifications do not capture the reality, even if they may help to organize our thinking about the topic. I believe there are many permutations of fact and experience.

A parting thought: there is an idea that any technology we use is an amplification and extension of our natural senses and abilities. Moreover, this kind of intensification changes our behaviour. A gangster behaves much differently with a gun than with a stick. It seems that the march of technology proceeds without much thought given to its effect on our behaviour.

Mar 31 2013:
I agree that technology cannot replace good doctors, and that we need to continue to train our doctors to interact with patients when making their diagnoses. However, one can not deny that technology has greatly enhanced the entire medical field. It is now much easier to detect certain diseases with the use of technology, and many new successful treatments have been developed against historically un-treatable diseases using the latest advances in technology. Obviously, technology has its faults and their diagnoses can be mistaken - but so can humans. Doctors are sued all the time for malpractice. I believe that by combining technology with the expertise and care from doctors, then we can greatly reduce mis or mal diagnoses and greatly improve the medical world.

Apr 2 2013:
I do not believe the medical profession has become too dependent on machines and technology when it comes to making medical decisions. Although I have no experience as a doctor or surgeon, I know that technology has only enhanced my engineering education and work outside of school. For this reason, I want to see technology as limitlessly useful in all fields.

Although I believe Karl Meyer was making a different point, I agree that technology is an amplification and extension of ourselves. Further, it is also an excellent defense against malpractice lawsuits which plague today's doctors and surgeons, as mentioned by Lauren Bayer.

If learning about the risks of relying to heavily on CDSS makes you nervous about your doctor or surgeon, it is important that you research your doctor or surgeon before trusting them. Speak with them, research their practice and investigate the hospital they may work in in order to learn about their experience and reliability, especially when using this technology.

Mar 31 2013:
I believe the experience of a doctor must always be used in order to validate and justify the findings of technological equipment. I think this issue you bring up goes far beyond just the medical field. How much can we as humans rely on technology, machines, and 'robots'? Machines are designed and programmed to do their job and only their job, doctors are trained to use their education, experience, and decisions to make clinical decisions. Such traits hopefully enable a doctor to make the correct diagnosis, but unfortunately that's not always the case. Hundreds of test can be run with different kinds of machinery, but it takes the keen eye of a doctor to make the resolute decisions. Unfortunately, both the machine and doctor are subject to error, but without one or the other, I don't think any patient can truly be treated properly.

Mar 30 2013:
We may first consider a case where diagnosis is effective. This is so with regard to machines whose ‘health’ can be monitored periodically or continuously by analyzing say vibration signals with good software. This is because the science involved is known though in rare cases there may be problems of interpretation.
The human machine is far more complex. While good technology picks up the signals accurately their interpretation is far more involved. Medical expertise of known doctors may be built in into the software but still it falls short.
The extent to which technological diagnosis can be used is not easy to define. Caution should be the watch word.
Another issue that concerns me is the diminishing role of general practitioner who has the capability to look at the patient in a holistic manner. Each expert is looking at one part of the body thoroughly as if they are independent. We should give more emphasis to general medicine and make it more valuable.
When experience really helps in diagnosis it may perhaps be termed insight rather than intuition. Any interesting idea like figuring out the disease by sensing the pulse alone by a vaid can be useful if it can be translated into a diagnostic tool for others as well. The validity of claims also then becomes established. Research is needed.

This question reminds me of this time last year, when my modern physics professor bemoaned the fact that we (the students) were of "the wolfram alpha generation." He said we had grown to depend on websites like wolfram alpha to solve integrals for us, and so our intuition wasn't where it should be, for engineering students who have to use calculus every day. Of course he was absolutely correct, and I think it applies here, as well. I think it's important to note that the machines are doing the jobs they were programmed to do, but also that there is a risk in putting too much faith in them. Doctors who use diagnostic machines on a daily basis can lose their intuition, and those that have trained only alongside the machines might not trust their intuition at all.

On the other hand, when a diagnosis is needed, it's needed as fast as possible. Misdiagnosis can happen whether it's coming from a person or from a machine, and the more resources we have, the better. Unfortunately, I've never worked in a hospital, so I can't really say the extent to which doctors actually do depend solely on the diagnosis from the machines, but I'd have to imagine that it's balanced with their own diagnoses and hunches.

Mar 31 2013:
Hi Hindi,
I do agree the the ideal situation would be a perfect balance between machine diagnoses and a doctor's own hunches. And you're right that misdiagnosis can happen from a person as well as the machine. I wonder if there was some way to ensure that the balance remained without one side being weighted more heavily than it should?

Mar 31 2013:
Before there were machines, there was Pulse Diagnosis.
Neema, this is such a relevant question today, and will continue to be so tomorrow. A small example; I work in the medical field, and operate one of the machines doctors rely on for diagnosis (and love my job), but I work in a small community of people, and when I inadvertently hear back from patients, friends, and even my co-workers in the field, the caregivers that work so hard, about all the medical bills they are slapped with for one ER or hospital or urgent care visit, I can't help but feel extremely guilty about my pay check that comes from the suffering of my friends and co-workers.
There are good, bad, and ugly scenarios in every situation, and I have experienced doctors ordering all kinds of tests without really spending time at the patient's bedside. I have also experienced patients who rely heavily on medicine to solve all the consequences of an unhealthy lifestyle, with no regard for their own bodies.

Mar 31 2013:
Hi Jasvin,
Very interesting perspective. Do you think there could be a way to prevent doctors from ordering multiple tests without first studying the patient themselves? I wonder if any standards be implemented so that a doctor is spending enough time looking for the problem himself balanced with the information received from tests?

Apr 1 2013:
Dear Neema
There is no way to prevent unnecessary tests except ethics. But ethics is difficult to define and more difficult to maintain. Speaking of experience in India only there are interesting ways of doing them. One is just in case.... My son suffered from severe headache and the doctor says 'I do not think there is any tumor problem. But just to rule it out please get a scan done'. The other is more direct-I am the doctor and I know what is to be done. Yet another problem sometimes is the routing of the patient.I went for treatment of mild case of spondyltis. The reception directed me to neurologist. After examining several X-rays of cervical zone plus tests in ENT(you have to walk with closed eyes+other tests) the diagnosis is mild spondylitis. The whole effort is costly. Is this all necessary? Suppose my spondilytis has deteriorated how do I know?The other way is first treat it as a mild case as the patient was free of the problem for three years with simple medication like Betavert tablets. Similar dilemmas exist. When should a heart by-pass be done? The interpretation of the level of blockage is the problem. If the surgeon is in a corporate hospital that 'expects' them to do a minimum number per month more bypasses than necessary can happen. Unfortunately good public hospitals that used to serve us well are deteriorating with few exceptions.
The above discussion is to elucidate the problem involved in developing criteria for ethics. But ethics do exist and the philosophy to promote is to say service first and money next.
Can something practical be done to check the problem?
probably internal audit by hospitals to see how effectively treatments were done and whether unnecessary tests were involved is a good starting point.

Mar 29 2013:
It depends. I recently thought I was having a heart attack. They kept me over-night during which time I didn't sleep and than made me do a stress test on a tread mill in the morning in a hot room. I thought they were trying to kill me. I wasn't in shape for that and had chest pains. And example where they don't use technology enough is that I believe the day will cone soon when no psychiatric diagnoses will be considered professional or compete without a sleep study. We spend billions on trying to hammer children into an appearance of normality which is just really acquiescence when the fact of tier behavioral issue could be tied to the level of sleep, whether they achieve delta waves and HGH is released to allow their brains to grown needed capacity. I think it's a primitive matter to deduce some kind of psychosis in a child and not even examine their sleep life, And that takes technology.

Mar 29 2013:
Well, I think technology is very very useful to understand the unknown world but it has also got some limitations. We have to take the results with pinch of salt. But in most case what doctors do is to rely heavily on test results for diagnosis. This may be because of human nature to protect one self from any kind of blames or responsibility.

In India, there were Aurveda doctors called " Vaid". They had excellent understanding of our body. I still remember, when I was 12, I had visited one such Vaid along with my father. He was around 65. He was diagnosing every patient by just pressing his hand on one's wrist & noting down the pulses. I still wonder how come he was able to diagnose the problem of any part of body by just watching pulses ? No instruments ! No tests ! And yes, he was no quake. I did a kind of small survey of patients & found that he was 98% correct about the diagnosis !

Though it is very sad that this kind of knowledge has not been passed to present generations but the point is that many of the ailments can be diagnosed without any tests but we have become very much dependent on technology and we are loosing faith on our own intelligence ! ( or may be we are not trying to test our intelligence ?)

Mar 29 2013:
Hello Jayprakash,
Wow, that is really incredible. I wonder if that was just a gift or a real skill that could be taught and passed along. I agree with you that human nature is to protect ourselves from blame and perhaps that is why it is easier to let the machines make the difficult decisions rather than face them ourselves.

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Mar 30 2013:
".....any illness is attributable to an imbalance of our inner energies, so they treat the cause rather than the symptoms." ya, that is the root of Aurveda system. And that is one of the reason that treatment as per Aurveda takes long time as it tries to treat the root cause. But the real paradox is that people do understand but do not have " time" and ultimately they prefer quick fix.

Mar 30 2013:
Oh, that was not just a gift. They do study Aurveda and after years of experience they are able to get hold of such quality. It is really skill & it is unfortunate that nobody is interested to acquire & learn that skill and because of that, the skill has almost died. I did try to contact such Vaids & all had one answer - we want to teach but nobody really interested are coming forward to learn this. Sad but true.

What I think should be done is to take knowledge of such persons and blending that with modern technology can provide us very low cost instruments that can diagnose most of our ailments.

Mar 28 2013:
Sharing my personal family experience of the machine and the medical specialist, in a nut shell. An electrical voltage fluctuation during an X-Ray of the Chest - the machine part. One of the leading Chest specialist is consulted, on the recommendation of the family doctor, he sees the x-ray and without much ado comes to the conclusion that Cancer is spreading fast, and rolls out a very grim scenario in front of the family members.

Thank God some one in the family has the good sense to seek another medical opinion. This time round the machine declares, nothing is wrong !! The family member lived hail and hearty for another 10 years.

Mar 28 2013:
the problem is that a symptom can a result of an absolutely huge number of possible medical causes. misdiagnosis may account for 17% of medical errors, but that figure would be far higher if technology wasn't available to eliminate some or most of those possibilities. are these errors a result of technology or despite it? do you have a figure for the percentage of misdiagnosis 20 years ago?

also if technology is still producing errors, surely the better option would be to improve the technology rather than just abandon it?

Mar 27 2013:
"Can machines ever be a good enough substitute for doctors?"

The key to this topic is "good enough". Diagnosis is never good enough. No one would have considered building a machine to help doctors with diagnosis decisions if doctors were good enough. Fortunately this is a question that can be answered by the scientific method. If you ask one of the people who sell these machines, I am sure s/he could provide you with the research studies that demonstrate that the machines improve the diagnosis results.

With all of our advances in medical knowledge, you would expect that medical practice would now be a very scientific process, and that misdiagnosis would be rare. Unfortunately, diagnosis is still, often, a doctor's best guess. In medical school they teach doctors that when in doubt, the more common diagnosis is usually right, so most doctors will never diagnose an uncommon condition.

The bigger and more important question is, why is diagnosis still more art than science?

IMO, the answer is the love of money. In the USA doctors are paid by the procedure. Diagnosis is not nearly as profitable as many other procedures. So diagnosis does not get the resources needed to get a quality diagnosis. The most critical resource is, of course, the doctor's time. Hence the critical economical opening for a machine to do the doctor's job. I am a big fan of capitalism, but it does have its down side.

Mar 27 2013:
Hi Barry,
Very interesting! I hadn't even considered the economic side of this, but I do think you are right. The way our system is set up now, the amount of time and money required for an excellent diagnosis is probably not available or entirely profitable for doctors. I just hope it does not come to a point where diagnosis is reduced to completely depending on a machine's output with little effort on the doctors part for the sole reason of being more profitable for the hospital or physician.

Apr 3 2013:
I agree with you on the diagnosis by the physicians is dependent on how much time and effort s/he could devout to a patient visit. However, this problem is actually more critical in Canada, and also in the U. S, because the physicians have generally either be "hired" by the government, or by the hospitals so that they are not allowed to spend too much time on a single patient. In the U. S. many physicians who take the Medicare patients will be paid by a fixed amount regardless of how much time you spend on him. And of course in 2014, almost all patients are being insured by the government programs. But the diagnoses by the machines in laboratories will be billed by the labs directly so the physicians don't have to worry about the restriction imposed on charges on lab tests. This certainly put a disincentive for more physicians' personal observation of the patients and instead to order lab tests. .Therefore this bad situation may or may not be caused by capitalism, and in my view this could be worse than a free-market medical practice system.

Apr 3 2013:
Great Question.
Yes.
Based on my hospital experience of a year ago, when I passed out & was taken to the ER.
Too many tests & not enough dialogue with the Drs.
And, when you're in that situation, suddenly, as a patient, your intuition and better judgement can become clouded.

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Mar 29 2013:
Hi Kate,
Very interesting! I have heard a lot about ancient techniques from Asian countries having been very accurate and useful for centuries. I wonder why we don't try and revisit some of those. Perhaps you're right, every aspect of our society has become so economically driven, hardly anything is developed unless it is monetarily beneficial.

Mar 28 2013:
as far as i can see, the doctors are becoming too much addicted towards the modern technology. but they miss the big picture. the life of a human being is at stake and only based on the decision a doctor makes their life can be saved. but they rely heavily on a machine as if its a god and what ever it says is true. the doctors should use only use it as a diagnostic tool and should never fully rely on their machines output. they can be used in simpler cases. but in complex cases you cant keep a knife on a human being only based on a machine's output & that too without full analysis of the report. its the stupidest thing you can ever make

Mar 28 2013:
Yes,Yes,Yes. I recently had a spell of what the doctors call numbness (I said it was tingly, the going to sleep feeling) that came and went in a matter of minutes over a three day period. Upon going to the doctor it was declared I was having a stroke. CT scans, multiple, and MRI's and sonograms and many other test showed nothing was wrong. No one ever asked about what foods, activities, or drug changes I might have experienced. The almighty machines ruled even though they could find nothing. I immediately made some life style changes and the problem ceased. I really don't know if the doc's were right or wrong, but their dependence on technology did not help them and they have not yet come up with a theory.

Mar 28 2013:
Hi Greg,
We could consider it from a patients point of view as well? If you felt something was wrong in your body but the doctor said tests appeared to be normal, would that be enough for you? Or would you press for the doctor to consider his own intuition or experience and spend a greater length of time trying to find the problem?

Mar 27 2013:
Hi I study nursing in S.Korea. In my short opinion, development of CDSS harm the intuitions which doctors have. However, there are many unfully trained doctors are in the medical field and only CDSS can help them to prevent to make mistakes. It is true that it has side effects as you mention in the body. in medical field, bad situation always happens in the ignore something. If doctors recognize a tumor as a inflammation, it gonna be a bad situation. However, if doctors think a inflammation as a tumor, it also going to be a bed situation but not bed as that. And this is reason way medical center hire professors and highly trained doctors; screening it. However by the develop ment of technology, we may not need doctors anymore.

Mar 27 2013:
The mark of the good doctor, I should think, is to use both intuition and the results of medical tests to come to her best conclusion but also to consider and communicate other possible diagnoses that may explain the symptoms the patient presents. Some doctors likely have great confidence in their intuition (whether those intuitions are in fact good or bad) and others are probably more reliant on other sources of data, including the possible interpretations of medical tests.

Mar 28 2013:
Hi Fritzie,
I absolutely agree, ideally some kind of combination of intuition and tests would likely yield the best results. But what happens if doctors become to comfortable just sitting back and letting the tests and machines speak? What if intuition is slowly ignored and forgotten?

Mar 28 2013:
I think doctors understand that tests help by providing some measures, but that the narrative including those data and other observations is for the doctor to construct with the help of his/her experience, intuition, and training. There would be nothing gratifying in sitting back and letting machines speak.

I think many people are quick to suggest other people might have the inclination to become comfortable and sit back lazily. A useful reality check might be to ask yourself, if you trained to make professional judgments by using your intuition together with the data tools can provide, do you imagine you would then just sit back comfortably and let tests and machines speak? If you believe you would not, why would you suspect such an inclination in others?

Mar 31 2013:
I wish we could rely on doctors being motivated by their work.

Unfortunately, a great many doctors are motivated by money. Many doctors who are not primarily motivated by money work for people who are motivated by money, and the employer determines the conditions of their employment and places limits on the way they work.

The motivation for money is not evil. We all work for a paycheck. Doctors and nurses are not evil because they want their children to go to good schools.

The problem with the medical industry is that our culture continues to believe in the illusion of a "health care system." When we recognize that we are dealing with an industry and start using the economics of that industry to improve the results, we will get better results. Medical professionals must compete.

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